HmarieD

HAHAHAHAHA That is hilarious :)

If you are a mandated reporter, you must report this to social services.

Per OASIS guidelines, if a patient can tolerate being up in a chair, even if they must be transferred via hoyer lift, they are chairfast.

I am so sorry you are going through this, and I totally get it... I felt the same way. I thought I had made the worst mistake of my life by becoming a nurse. Luckily, I was able to move to a specialty area that I love. I started in Home Health and it was like the clouds parted for me, I've been doing this for 12 years and never looked back. You should look around at other opportunities, there are so many things you can do as a nurse that one of them is bound to be just the thing for you. Good luck.

No, I wouldn't just show up on the off chance that I would be able to work. However, I would think that the nurse or her agency would have been monitoring his status so they would know when he was discharged home. Having said that, did you notify the agency that your son was home and his care should resume?

You may not be homebound if...you brag to me about the hot babe you bagged when you hit all the bars on your birthday.

My advice to you in working with the surveyors is: 1) remain calm. 2) Do not be afraid to say "I don't know, but I will find out and get back to you", rather than trying to BS your way through an answer. 3) When a pt record is requested for review, make sure your clerical staff pulls every single thing from every possible place (filing, etc). Give it a quick look if time allows. 4) Make sure the surveyors have clear directions to the pt homes and someone to follow if necessary, they get really irritable when they get lost and nobody wants that :) 5) Instruct the nurses prior to the home visits to make sure they are clear on bag technique, handwashing, all infection control issues. And, tell them if they make a mistake to stop, acknowledge it, and indicate what they should have done differently, instead of continuing to blunder through. (for instance, if they forget to wash hands and change gloves between removing soiled dressing and applying clean dressing). At least the surveyor will know that is not their usual practice. 6) Answer questions as concisely as possible. Do not get chatty, these people are not your friends and do not sympathize with the hardships you face in your job. Keep it short and sweet. 7) Again - REMAIN CALM. Freaking out only makes people wonder what it is you're so freaked out about. 8) Never enter the room without a notebook. They will inevitably ask for 15 things which you will never remember. Take copious notes. Good Luck! Remember the survey itself is the easy part, the hard part comes later, when you have to write the Plan of Correction and carry it out.

I am an Illinoisan as well - maybe we should have our own happy hour, I'm certainly ready for one right now! TGIF!

I would only add one thing to KateRN1's excellent response - if the last OASIS-qualified clinician who saw the patient was still employed there (RN, PT, OT), they would be responsible for the DC OASIS, and would base their responses on the condition of the patient at the time of that clinician's last visit. She is correct that the situation as decribed is perfectly legal and in fact the only way it can be managed, assuming you are the supervisor or case manager.

KateRN1 - Will you please come work at my agency? You are always right on the money!! I want to steal you away from wherever you are!

Medical Director is not required in all states.

Medicare does not consider HHA services medically necessary if there is a "willing and able" c/g in the home, even if that c/g is a family member, as Kate said it's a duplication of services.

This forum is specific to Home Health, I think there is a Hospice forum you might have better responses from. Good luck.

I always ask the same question! My favorite response was the gentleman who, every morning, drank 2 oz of red wine mixed with OJ. Now that's a health craze I can get behind!

Remember that every single clinical note must stand alone; in other words, you should be painting a complete clinical picture every time you document. Your documentation of tasks such as wound care must echo your plan of care and should be in excruciating detail (cleanse w/___, apply___, cover w/___, secure w/___, aseptic technique). Remember to document any and all care coordination (communication with any member of the health care team, including caregivers, DME providers, physicians, clinical supervisors, etc., etc.). Always address progress (or lack of progress) toward goals as they are stated in the plan of care. Always make sure you are demonstrating homebound status, if applicable, and skilled need and medical necessity. Indicate why the pt continues to require HH services. These are just some of the areas I do not see done well when I audit a record.